Parenteral Flashcards
Parenteral means administered in a manner other than _________________
Through the digestive tract
Name 3 circumstances in which parenteral routes are used
- vomiting - cannot swallow - restricted from taking oral fluids
When administering parenteral medication, what “cleaning” technique do you use?
aseptic
Name and describe the four routes for parenteral administration
- Intradermal (ID): into dermis just under epidermis 2. Subcutaneous: into tissues just under the dermis 3. Intramuscular (IM): into the body of a muscle 4. Intravenous (IV) injection or infusion: injection into a vein
Name five complications that can occur if you fail to inject a medication correctly
- inappropriate drug response (too rapid or too slow) - nerve injury with associated pain - localized bleeding - tissue necrosis - sterile abscess
What is the best site for IM injections? Why were nurses reluctant to use this site?
Ventrogluteal difficulty in anatomically locating it and belief it isn’t safe
What are the four Principles of preventing infection during an injection? What techniques should be used for each?
- Prevent contamination of solution (ampules closed, med removed quick)
- Prevent needle contamination (avoid touching contam. surface; avoid touching length of plunger, keep tip covered)
- Prepare skin (wash soiled with soap/water, friction and circular motion with antiseptic swap, swab from center of site and move outward in a 5-cm (2-inch) radius
- Reduce transfer of microorganisms (perform hand hygiene for a minimum of 15 seconds)
VENTROGLUTEAL
Advantages:
Preferred site for what kind of medications:
Pain compared to vastus lateralis:
Recommendations for children:
Advantages: deep and away from major nerves/blood vessels; easily identified by prominent bony landmarks
Preferred site for what kind of medications: large in volume, more viscous, irritating
Pain compared to vastus lateralis: less painful
Recommendations for children: pediatric IM injection site for children of all ages
VASTUS LATERALIS
Advantages:
Used for what in children:
Pediatric recommendations:
Advantages: absence of major nerves/blood vessels, drug absorption rapid
Used for what in children: immunizations
Pediatric recommendations: IM injection site for infants up to 12 months of age
DELTOID
Advantages:
Disadvantages:
What kind of meds used for:
May be used for what in adults:
Pediatric recommendations:
Advantages: easily accessible, faster absorption rate
Disadvantages: not well developed in most patients
What kind of meds used for: small volumes
May be used for what in adults: vaccination (depending on development of muscle)
Pediatric recommendations: IM injection site for children 18 months and older
Six Rights of Med Admin
- Right person
- Right time
- Right route
- Right dose
- Right drug
- Right documentation
10 Guidelines to follow to ensure safe med admin
- be vigilant (know your shit)
- expiry date
- 2 identifiers
- clarify/ask for help
- use technology-no workarounds
- strict aseptic technique during prep and admin
- educate patients during admin
- don’t delegate
- no-interruption zones
- minimize patient discomfort
What is a “workaround”? How and why do nurses use them?
A “workaround” bypasses a procedure, policy or problem in the system.
They fail to follow agency policies, protocols, or procedures in an attempt to admin meds faster
12 ways to minimize patient discomfort during injection
- use sharp, beveled needle in the shortest length/smallest guage
- change needle if liquid coats shaft
- position and flex pt’s limbs to reduce muscular tension
- divert pt’s attention
- apply vapocoolant spray or topical anesthetic or place wrapped ice for a minute before
- insert needle at proper angle, smoothly and quickly. don’t hesitate
- inject med slowly but smoothly
- hold syringe steady once needle is in tissue to prevent tissue damage
- withdraw the needle smoothly at same angle used for insetion
- gently apply antiseptic pad or dry sterile gauze pad to site
- apply gentle pressure at injection site
- rotate injection sites to prevent formation of indurations and abscesses
What is the most frequent route of exposure to bloodborne disease for health care workers? Where is this most likely to occur? When do they occur?
Needlestick injuries
In pt rooms and the OR
When HCWs recap needles, mishandle IV lines and needles, or leave needles at pt bedside
8 Recommendation for the Prevention of Needlestick injuries
- avoid needles when effective needleless systems or SESIP safety devices are available
- do not recap after admin
- plan safe handling and disposal before beginning
- immediate disposal in sharps container
- maintain sharp injury log
- attent educational offering and follow recommendations (incld. receiving hep B vaccine)
- report all needlestick injuries
- participate in selection and eval of SESIP devices
What is a SESIP? Name 2 types
Sharp with engineered sharps injury prevention (SESIP)
blunt-end cannula; safety syringe equipped with plastic guard or sheath that slips over needle as it is withdrawn from skin
What are 4 requirements for sharps containers?
- only one hand needs to be used
- stand upright
- not allowed to overfill
- be colored red or labeled with biohazard
When administering parenteral injections, you must first determine 43things:
These determinations are based on 3 things:
- appropriate size, length, and guage of needle; volume of solution; medication route
- quantity of med, type of med, body size of pt
What do electronic infusion pumps do?
ensure a constant and accurate delivery of medication
Syringe capacity ranges from ___mL - ___mL
0.5 mL - 60 mL
It is unusual to use a syringe larger than ___ mL for IM injections
5 mL
Why are large volumes of meds not good?
create pain and dicomfort for pt
Syringes are most commonly marked in a scale of ________
tenths of a million
What kind of syringes do you use to prepare small amounts of medication for ID and subQ injections?
tuberculin (TB) syringes
What are 3 things you would use a larger syringe for?
- IV medications
- add meds to IV solutions
- irrigate drainage tubes
Some syringes require you to change the needle based on 3 considerations
- viscosity of medication
- route of administration
- size of patient
Most insulin syringes are U-____, designed for use with U-_____–_______ insulin
Each mL of solution contains _____ units of insulin
Insulin syringes hold ___ - ___ mL (__ units per __ mL or __units per __mL)
Do insulin syringes come with or without pre attached needles?
U-100; U-100-strength
1 mL=100 units
0.3 mL to 1 mL (30 units per 0.3 mL or 50 units per 0.5 mL)
With preattached needles
What are the three parts of a needle?
All three parts must remain _____ at all times
To prevent contamination, use ___________ with the cap intact
hub: fits onto tip of syringe; shaft: connects to hub; bevel aka slanted tip
STERILE
use gentle force to place the needle onto the syringe with the cap intact
The tip of the needle, or bevel, is always _____
slanted
How does the slanted tip bevel help?
it creates a narrow slit when injected into tissue that quickly closes after the needle is removed to prevent leakage of medication, blood, or serum
True or false: shorter beveled tips are sharper and narrower, which minimizes tissue discomfort during a subQ or IM injection
False! Longer tips are
Most needles vary in length from _____ to ____
3/8 to 3 inches
Use _____ needles ( ___ to ___) for IM injections
Use _____ needles (__ to ___) for SubQ
IM: longer (1 inch - 1 1/2 inch)
SUBQ: shorter (3/8 - 5/8 inch)
Choose the needle length according to which 3 factors:
- patient’s size and weight
- type of tissue to be injected
- route of administration
The (smaller/larger) the needle gauge, the (smaller/larger) the needle diameter
The SMALLER the needle guage, the LARGER the diameter
The guages of needles are ________ for ease of selection
color coded
The selection of a guage depends on what?
The viscosity of fluid to be injected
Match the type of needle you would use to the route of administration
- 25-gauge 5/8-inch needle
- 22-gauge 1 1/2-inch needle
Options:
- IM
- IV
- ID
- SUBQ
- 25-gauge 5/8-inch needle (SUBQ)
- 22-gauge 1 1/2-inch needle (IM)
Prefilled unit-dose systems such as _______ and _____ injection systems use what two items of equipment?
Tubex and Carpuject
reusable plastic syringe holders and disposable, prefilled, sterile, glass cartridge units
Put the following steps in order–using a prefilled system
- stop turning when you hear click
- dispose of glass cartridge in sharps container
- turn plunger rod to the left (counterclockwise)
- follow manufacturers instruction
- advance plunger to expel air and excess med
- remove needle guard
- place cartridge, barrel first, into the plastic syringe holder
- turn plunger rod to the right (clockwise)
a. place cartridge, barrel first, into the plastic syringe holder
b. follow manufacturers instruction
c. turn plunger rod to the left (counterclockwise)
d. turn plunger rod to the right (clockwise)
e. stop turning when you hear click
f. remove needle guard
g. advance plunger to expel air and excess med
h. dispose of glass cartridge in sharps container
Ampules:
- single doses, multiple doses, both
- What form are they available in?
- Available in sizes from ___ to ___ mL
- What must you use when withdrawing medication from ampule
- Should you push air in before taking med out?
- single dose
- liquid form
- size: 1 to 10 mL
- filter needles
- no
Vials:
- What should you do after you open a single-dose vial?
- What should you do after you open a multiple-dose vial?
- What forms do vial contain?
- What are the two most common solutions used with dry medications
- What kind of system is a vial? What does this mean you have to do?
- Do medications need to be drawn up with a filter?
- Why might a prescriber order an injectible med that must be reconstituted?
- discard it
- can be used several times, but only for a single patient; write the date the vial is opened–verify with agency how long an opened vial may be used; discard when time is expired
- liquid or dry
- sterile distilled water and normal saline
- closed-system–you must inject air into vial to permit easy withdrawal
- Some may because of nature of medication–indicated by agency policies and package inserts
- time-sensitive injectable med, must be admin within a specific time period to guarantee full effectiveness
Assess the following 3 patient characteristics before giving a SUBQ or IM injection
- body build
- muscle size
- weight
Why shouldn’t you use an opened alcohol swab to open an ampule? What should you use instead?
Alcohol may leak into ampule; use small gauze pad
When drawing up a med from an ampule; use a filter needle long enough to reach ________
Hold ampule _____ or ______
bottom of ampule to access med
upside down OR set on flat surface
How much air should you inject into a vial?
How should you position the vial when injecting air?
What should you do after?
equivalent to volume of medication to be aspirated from vial
on flat surface
invert after
What should you include on the label of a multi-dose vial?
- date of opening
- concentration of drug per mL
- initials
When drawing up reconstituted medication, should you add air to vial?
NO
When you mix meds from a vial and an ampule, you prepare meds from the (vial/ampule) first.
Then you withdraw medication from the vial/ampule using same/different syringe and a _____ needle
vial first
then from ampule using same syringe and a filter needle
What is insulin classified by?
rate of action, including short duration, intermediate duration and long duration
Which type of insulin should you prepare first if mixing?
short- or rapid-acting